摘要目的:探讨桡动脉作为第二动脉旁路在冠状动脉旁路移植术（CABG）中的临床应用结果。方法:回顾性分析2008年4月至2019年8月在南京医科大学附属南京医院心胸血管外科同时使用左胸廓内动脉和桡动脉进行旁路移植的连续585例患者的临床资料。男性436例，女性149例，年龄（63±10）岁（范围：36~86岁）。有糖尿病史者占40.7%（238/585），多支血管病变者占75.6%（442/585）。2017年1月后的手术患者接受旁路血管的术中即时流量测定。对2014年1月至2019年8月手术患者的随访结果进行分析。结果:体外循环手术占81.9%（479/585），11例患者使用主动脉内球囊反搏，43例患者同期接受瓣膜手术。远端吻合口（3.6±0.9）个（范围：2~6个），动脉旁路远端吻合口（2.1±0.3）个（范围：2~5个），560例患者桡动脉旁路吻合至钝缘支。靶血管近端狭窄程度均>70%，>90%者占72.5%（424/585）。151例患者术中即时流量测定结果显示，桡动脉旁路流量为（29.8±10.2）ml/min（范围：10~150 ml/min），搏动指数2.5±1.4（范围：0.7~5.0）。本组患者无围手术期死亡，术后30 d后院内死亡2例，无围手术期心肌梗死。近5年手术的188例患者中位随访3.2年，非心源性死亡2例，无心肌梗死发生，无需再血管化治疗病例。结论:桡动脉作为第二动脉旁路用于CABG安全有效，良好的靶血管选择和术中即时流量测定有助于取得满意的旁路通畅率和近中期疗效。

abstractsObjective:To examine the clinical experience and outcomes of coronary artery bypass grafting (CABG) using radial artery as the second arterial graft.Methods:Totally 585 patients in whom both left internal thoracic artery and radial artery as arterial conduits were used in CABG in Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University from April 2008 to August 2019 were consecutively enrolled. There were 436 males and 149 females, aging (63±10) years (range: 36 to 86 years). There were 40.7%(238/585) of patients had diabetes and 75.6%(442/585) of them had multivessel disease (two-vessel or three-vessel diseases). From January 2017, transit time flow measurement was performed on every patient. Demographic and perioperative data were retrospectively collected, as well as follow-up data for patients who underwent CABG from January 2014 to August 2019. Analysis were made on their early and late outcomes.Results:Most patients(81.9%(479/585)) in this cohort received on-pump CABG and 11 patients had intraoperative intro-aortic balloon counterpulsation (prior to CABG) support. Forty-three patients had concomitant valve procedures. The number of distal anastomosis was 3.6±0.9 (range: 2 to 6) and number of arterial distal anastomosis was 2.1±0.3(range:2 to 5). Radial artery was anastomosed to left obtuse marginal artery in 95.8%(560/585) patients. All target vessels for radial artery conduit had significant proximal stenosis (>70%) and 72.5%(424/585) patients′ target vessels had proximal stenosis which was >90%. Intraoperative transit-time flow measurement of 151 cases showed that radial artery conduits had a flow of (29.8±10.2) ml/minutes (range: 10 to 150 ml/minutes), and a pulsatility index of 2.5±1.4 (range: 0.7 to 5.0). There was no operative death. Two in-hospital deaths occurred more than 30 days after index surgery. There was no perioperative myocardial infarction. There were 188 patients who received CABG from January 2014 to August 2019 followed-up for a median duration of 3.2 years. There were 2 noncardiac deaths. No patient had myocardial infarction or myocardial revascularization.Conclusions:Radial artery as the second arterial conduit is a safe and effective strategy for CABG. Good selection of target vessel and intraoperative transit-time flow measurement may help achieve good patency, as well as the short and mid-term outcome.